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21 Cards in this Set

  • Front
  • Back
Kroenke & Price (1993)
- Large community sample
- Lifetime prevalence of 26 common symptoms
- 31% no medical diagnosis or explanation
Koch et al. (2009)
- MUS tend to persist for long time
- 43% of 254 patients with unexplained fatigue, abdominal or musculoskeletal complaints still had complaints (still unexplained) 1 year later
-People with lots of persistent MUS tend to consult doctor a lot - “frequent attenders”
Simon & Vonkorff (1991)
- Study of co-occurrence of MUS and psychiatric symptoms in large community sample
- More MUS: greater likelihood of anxiety and depression symptoms
Somatization
- Psychological distress expressed as physical symptoms
- Patients feel symptoms are delegitimised
- Little evidence
Attributional Style
- Normalising: environmental causes
- Psychologising: psychological causes
- Somatic: illness causes
- Kirmayer & Robbins (1991)
Pawlikowska et al. (1994)
- Fatigue symptoms positively correlate with distress
Rejecting Explanations
- Dr denies reality of symptoms, implies its imaginary disorder
- Cause distrust of Dr
- Salmon, Stanley, Peters, BMJ (1999)
Colluding Explanations
- Dr agrees with patients explanation
- Causes patients to question Dr's openness and competence
- Salmon, Stanley, Peters, BMJ (1999)
Empowering Explanations
- Dr suggests tangible mechanism as explanation, free from guilt with opportunity for self-management
- Legitimizes patients suffering, removes blame
- Allies Dr and patient
- Allows for discussion of psychological features
- Salmon, Stanley, Peters, BMJ (1999)
Kroenke & Swindle (2000)
- Systematic review of 31 controlled trials of CBT for MUS
- 12 month improvement compared with
treatment as usual in:
– Physical symptoms
– Functional status
– Emotional distress
Reattribution Therapy
- Adaptation of CBT to primary care
- Stages:
1) Feeling understood: explore illness belief, respond to emotional cues
2) Broadening the agenda: exploration of emotional factors
3) Making the link: e.g. Stress response, muscle tensions
4) Collaborating on a treatment or management approach
Morriss & Gask (2002)
- 150 patients before GPs trained compared
with 150 patients after training
- Improvements in patient satisfaction and decrease in patient somatizing beliefs
- BUT, no benefit of reduction in healthcare use
Chronic Fatigue Syndrome
- Over 6 months of severe, disabling fatigue
- Significantly affects work, social and leisure functioning
- Additional symptoms: pain, sleep problems, memory and concentration problems
Puetz (2006)
- Active people less likely to experience fatigue than sedentary people
- Association is robust
- Activity precedes feelings of greater vigour
- Dose-response relationship
Dysregulation Hypothesis of Chronic Fatigue Syndrome
- Reduced activity levels leads to:
- Deconditioning (adapting to inactivity)
- HPA axis (stress hormones) dysregulation
- Sleep disturbance
- THEN, difficulties when activity resumed leading to fear and demoralisation
White et al. (2011)
- Graded exercise therapy and CBT more effective reducing fatigue and improving physical functioning than adaptive pacing therapy or standard medical care
Moss-Morris et al. (2005)
- Improvements in fatigue after graded exercise therapy mediated by decreased symptom focusing
Wearden & Emsley (2013)
- Improvements in fatigue after graded exercises therapy mediate by decreased activity limitation and catastrophising
- Not increased fitness
Mindfulness Based Stress Reduction (MBSR)
- Used to treat chronic pain (e.g. chronic widespread pain and fibromyalgia)
- Seeing self in context
- Awareness of own experiences without too much attachment; accepting and non-judgemental
- Kabat-Zinn (1994)
Cognitive Behavioural Model of Chronic Pain
- 'Fear-avoidance model'
- Non-threatening interpretation = lower fear, confrontive coping, maintaining activity, recovery and reduced future pain
- Catastrophising interpretation = fear, avoidance of activity, physical disuse, disability, depression, more likely to experience pain
Schutze et al. (2010)
- Measured all aspects of fear avoidance model
- Greater mindfulness associated with lower pain intensity, disability, negative affect, catastrophizing, fear and hypervigilance
- When other variables controlled for, only mindfulness predicted lower catastrophizing (which predicts lower pain)